Diabetes mellitus in the East: its treatment

Abstract

Diabetes is one of the most common diseases of India and as from time immemorial it has been known to be more general among the Hindus than among any other race in the world I have selected this subject for my thesis.India, as is known to everybody, is a vast country with a population of over three hundred millions. It would therefore be a presumption on my part if I were to say that I have studied Diabetes in every part of the Country. My experience and observations are confined to the parts where it has been my privelege to serve the Government of India either as a Military Medical Officer or as a civil surgeon.True Diabetes, in my opinion, is a disease by itself, just as much as Tuberculosis or chronic nephritis is, although its real causation is so far not very clear. It has a great deal to do with the Pancreas. Its chief feature is the disorder of sugar metabolism and its most constant symptom glycosuria.Diabetes in the East is essentially the same as it is in Europe. There is extraordinary variety in its course in which alimentary factor, other endogenous factors, climatic conditions and individual peculiarities play a very important part but from glycosuria to Diabetes difference is only of degree and not of kind.Moderation in carbohydrates is to the advantage of,the patient but their entire exclusion for any length of time is decidedly injurious both physically and mentally. No part of the food is more nourishing than carbohydrates and calories derived from them protect body tissues better than those derived from fats or proteins.Meat is absolutely unnecessary in the treatment of Diabetes. In fact it is just as injurious in this disease as it is in chronic Bright. sugar in excess is a toxin in the system and the work of its excretion is thrown upon the kidneys. It is most unwise to overtax them at this time with meat diet and thus hasten their breakdown. Proteins, besides, increase acetone bodies by taking away a part of the oxygen for themselves and thus not giving the acetone bodies full chance of being oxidised.Severe cases run a rapid course in India as the Patients cannot sufficiently be controlled in their own homes and there are no sanatoria or nursing homes to welcome them. Mild cases on the other hand live much loner in India than they do in Europe, because Indian physicians do not believe in rigid diet and never exclude carbohydrates entirely from their patient's food for any length of time. rigid diet as suggested by Rollo is unknown to them. They limit the use of carbohydrates but give plenty of milk and 'ghee' and never meat. I have known in my own friends, people who have lived for 25 & 30 years on milk diet.Fasts as proscribed by the Hindu religion, are in my opinion a god-sent-thing for the Diabetic. Diabetes being a disease of disturbed metabolism nothing seems to restore the equilibrium of the system so quickly and so well as occasional fasts. every good Hindu observes fast on the full moon and on the 11th of the month and they can be well utilised in the treatment of Diabetes.Alcohol, although its caloric value is very high, is repulsive to the feelings of the Indian people and need not be used. I have used it only as . -medicine under special circumstances to avert the dangers of coma for a while. Its persistent use, in my opinion, slows the digestive process and checks those protective agencies upon which the safety of the patient depends.Exercise in Diabetes is one of the most essential elements of treatment. Over and over again I have seen it improving the assimilative powers of my patients in a most gratifying manner. With a regular constitutional morning and evening they were able to take starch in quantities sufficient for their requirement without showing glucose in the urine. They put on flesh, their sexual appetite returned and for all intents and purposes they lived just like other healthy persons. Walking is the best form of exercise in India as the weather is always fine and walking requires no training and is within the means and powers of everybody. Exercise prevents constipation also.Diet, exercise and drugs were useful in mild cases only. In the severe stage nothing seemed to do any good and patients died sooner or later.